36A79722Q0013_1.docx

36A79722Q0013

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1. REQUISITION NO.

2. CONTRACT NO.

3. AWARD/EFFECTIVE DATE

4. ORDER NO.

5. SOLICITATION NUMBER

6. SOLICITATION ISSUE DATE

a. NAME

b. TELEPHONE NO. (No Collect Calls)

8. OFFER DUE DATE/LOCAL

TIME

9. ISSUED BY

CODE

10. THIS ACQUISITION IS

UNRESTRICTED OR

SET ASIDE:

% FOR:

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

8(A)

NAICS:

SIZE STANDARD:

11. DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

SEE SCHEDULE

12. DISCOUNT TERMS

13a. THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13b. RATING

14. METHOD OF SOLICITATION

RFQ

IFB

RFP

15. DELIVER TO

CODE

16. ADMINISTERED BY

CODE

17a. CONTRACTOR/OFFEROR

CODE

FACILITY CODE

18a. PAYMENT WILL BE MADE BY

CODE

TELEPHONE NO.

UEI:

EFT:

PHONE:

FAX:

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER 18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW IS CHECKED

SEE ADDENDUM

19.

20.

21.

22.

23.

24.

ITEM NO.

SCHEDULE OF SUPPLIES/SERVICES

QUANTITY

UNIT

UNIT PRICE

AMOUNT

(Use Reverse and/or Attach Additional Sheets as Necessary)

25. ACCOUNTING AND APPROPRIATION DATA

26. TOTAL AWARD AMOUNT (For Govt. Use Only) 27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA

ARE

ARE NOT ATTACHED.

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA

ARE

ARE NOT ATTACHED

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN _______________

29. AWARD OF CONTRACT: REF. ___________________________________ OFFER

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND

DATED ________________________________. YOUR OFFER ON SOLICITATION

DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY

(BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE

ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED

SET FORTH HEREIN IS ACCEPTED AS TO ITEMS:

30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER) 30b. NAME AND TITLE OF SIGNER (TYPE OR PRINT) 30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (TYPE OR PRINT) 31c. DATE SIGNED

AUTHORIZED FOR LOCAL REPRODUCTION

(REV. NOV 2021)

PREVIOUS EDITION IS NOT USABLE

Prescribed by GSA - FAR (48 CFR) 53.212

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES

OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

36A79722Q0013 07-13-2022

09-07-2022 11:59pm

CDT

36A797 Department of Veterans Affairs National Acquisition Center Building 37 1st Avenue, One Block North of Cermak Hines IL 60141

X

334517 1000 Employees

N/A X

36A797 Department of Veterans Affairs National Acquisition Center Building 37

36A797 Department of Veterans Affairs National Acquisition Center Building 37

See CONTINUATION Page Please see attached Instructions for Offerors for the May 2022 Consolidation.

(SEE CONTINUATION PAGES)

Vendor Total

19.

20.

21.

22.

23.

24.

ITEM NO.

SCHEDULE OF SUPPLIES/SERVICES

QUANTITY

UNIT

UNIT PRICE

AMOUNT

32a. QUANTITY IN COLUMN 21 HAS BEEN

RECEIVED

INSPECTED

ACCEPTED, AND CONFORMS TO THE CONTRACT, EXCEPT AS NOTED: _______________________________________________________ 32b. SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE 32c. DATE 32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT REPRESENTATIVE 32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE 32f. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE 32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE

33. SHIP NUMBER

34. VOUCHER NUMBER

35. AMOUNT VERIFIED CORRECT

36. PAYMENT

37. CHECK NUMBER

FOR

PARTIAL

FINAL

COMPLETE

PARTIAL

FINAL

38. S/R ACCOUNT NUMBER

39. S/R VOUCHER NUMBER

40. PAID BY

41a. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT 42a. RECEIVED BY (Print) 41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER 41c. DATE 42b. RECEIVED AT (Location) 42c. DATE REC'D (YY/MM/DD) 42d. TOTAL CONTAINERS

STANDARD FORM 1449 (REV. NOV 2021) BACK

Delivery Order/Receiving Report Instructions

1. This delivery order also serves as the receiving report.

2. The signed and dated receiving report serves as documentation of authorization for payment of goods or services.

3. When the Equipment is delivered to the receiving service, completion of Blocks 32a-32g acknowledging the official receipt of the item(s) is required.

4. Provide a copy of the order and the first page of all modifications to the NAC Contracting Officer within seven (7) business days of receipt of equipment.

5. If confirmation is not received within seven (7) business days of receipt of equipment, contractor's commercial proof of delivery will be accepted in lieu of customer's receiving report. The 80% interim payment will be authorized.

NOTE: Signing the Receiving Report does not constitute acceptance. Final acceptance of the equipment and installation will be based upon an inspection and test.

The vendor will notify the NAC when the equipment is ready for inspection. The final 20% payment will then be authorized following an acceptable inspection. For patient safety, we highly recommend that the system be tested by your local Medical Physicist and that

Applications Training on the system be completed prior to first clinical use.

SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS

See attached document: RFQ Instructions to Offerors - May 2022 Consolidation.

See attached document: May 2022 Consolidation Schedule.

See attached document: May 2022 Consolidation - Schedule of Line Items - Updated 7-13-22.

See attached document: 436B20008 - 460B28019 TS.

See attached document: 459B26005 - 578B28009 BM.

See attached document: 499B29003 - 531B24002 TS.

See attached document: 534B22028 - 554B23018 TS.

See attached document: 558B20021 - 583B20036 TS.

See attached document: 580B20049 BM.

See attached document: 580B20052 - 672FC2002 BM.

See attached document: 583B20056 - 600B20026 TS.

See attached document: 629B20019 - 648B12487 TS.

See attached document: 648B22537 - 663B23007 TS.

See attached document: 663B23013 - 668B23000 TS.

See attached document: 673B22012 - 673B22014 BM.

See attached document: 673B22027 - 673B22028 BM.

See attached document: 673B22038 - 675B27006 BM.

See attached document: 673B22039 - 674B20104 TS.

See attached document: 674B20105 - 740B20014 TS.

See attached document: 675B27007 BM.

See attached document: 675B27008 - 695B28006 BM.

See attached document: Vendor Folders.

See attached document: Vendor Workup Spreadsheet - 36A79722Q0013.

See attached document: VA Directive 6550 - New Appendix A - published Jun. 2019.

See attached document: Memorandum for Turnkey.

See attached document: Memorandum for Training.

See attached document: MAX Drive HTME User Guide.

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